Provider Demographics
NPI:1760068787
Name:GALLIMORE, TAYLOR O (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TAYLOR
Middle Name:O
Last Name:GALLIMORE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 ANDREW AVE APT 269
Mailing Address - Street 2:
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-4349
Mailing Address - Country:US
Mailing Address - Phone:203-545-9701
Mailing Address - Fax:
Practice Address - Street 1:98 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-4349
Practice Address - Country:US
Practice Address - Phone:860-325-2652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-21
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0112141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical